Organization
FAMILY & COSMETIC GENTLE DENTISTRY, LTD
Active
Parent organization
FAMILY & COSMETIC GENTLE DENTISTRY, LTD
Organization subpart
Yes
Provider details
NPI number
Legal business name
FAMILY & COSMETIC GENTLE DENTISTRY, LTD
Authorized official
DIANA GAVIC (OPERATIONS MANAGER)
(952) 224-9771
Entity
Organization
Contact information
Practice address
13550 26TH AVE N STE 200, PLYMOUTH, MN 55441-3650
(763) 557-0287
(763) 557-0295
Mailing address
6600 FRANCE AVE S, 415, EDINA, MN 55435-1805
(952) 224-9771
(952) 224-9790
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
190110900
—
MN
Enumeration date
11/27/2007
Last updated
06/20/2008
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